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Endoscopic Gastrojejunal Revisions Following Gastric Bypass: Lessons Learned in More Than 100 Consecutive Patients

  • 2018 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Weight regain and dumping after Roux-en-Y gastric bypass (RYGB) are long-term challenges thought to be due to dilation of the gastrojejunal anastomosis. The aim of this study was to analyze the feasibility, safety, and outcomes of endoscopic gastrojejunal revisions (EGRs) after its introduction in a tertiary bariatric surgery center.

Methods

From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing EGR with the OverStitch suturing device. Demographics, procedure details, and outcomes were recorded.

Results

There were 107 patients (M:F = 29:78) treated with 133 EGR procedures for weight regain (n = 81), dumping syndrome (n = 13), or both (n = 13) with mean age 47.3 years (R 22.0–72.9) and mean BMI 32.9 kg/m2 (R 22.2–49.8) at time of procedure. Mean procedure time was 17.8 min (R 12–41), with median 1 suture used (R 1–2). No intra-operative or 30-day complications were recorded. Mean follow-up time was 9.2 months (R 1–26.8). Patients lost a mean of 4.1, 5.8, and 8.0 kg at 3, 6, and 12 months, respectively, after the procedure. Weight loss outcomes were significantly better when two compared to one suture was used (p = 0.036), and for patients with higher starting BMI (p = 0.047). For patients with dumping syndrome, 90–100% had treatment response after one or two EGRs.

Conclusion

EGR is feasible and safe for weight regain and dumping syndrome after RYGB. It can stabilize weight regain and improve dumping symptoms. Around 20% of patients will need repeat EGR within 1 year to achieve sufficient narrowing of the anastomosis.

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References

  1. Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, Hollenbeck A, Leitzmann MF: Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006;355:763–778.

    Article  CAS  PubMed  Google Scholar 

  2. Sjöström CD: Surgery as an intervention for obesity. Results from the Swedish obese subjects study. Growth Horm IGF Res 2003;13 Suppl A:S22–26.

    Article  PubMed  Google Scholar 

  3. Cai JX, Schweitzer MA, Kumbhari V: Endoscopic Management of Bariatric Surgery Complications. Surg Laparosc Endosc Percutan Tech 2016;26:93–101.

    Article  PubMed  Google Scholar 

  4. Pories WJ: Bariatric surgery: risks and rewards. J Clin Endocrinol Metab 2008;93:S89–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Abu Dayyeh BK, Lautz DB, Thompson CC: Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol 2011;9:228–233.

    Article  PubMed  Google Scholar 

  6. Fernández-Esparrach G, Lautz DB, Thompson CC: Peroral endoscopic anastomotic reduction improves intractable dumping syndrome in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis 2010;6:36–40.

    Article  PubMed  Google Scholar 

  7. Linner JH, Drew RL: Reoperative surgery--indications, efficacy, and long-term follow-up. Am J Clin Nutr 1992;55:606S–610S.

    Article  CAS  PubMed  Google Scholar 

  8. Thompson CC, Chand B, Chen YK, Demarco DC, Miller L, Schweitzer M, Rothstein RI, Lautz DB, Slattery J, Ryan MB, Brethauer S, Schauer P, Mitchell MC, Starpoli A, Haber GB, Catalano MF, Edmundowicz S, Fagnant AM, Kaplan LM, Roslin MS: Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology 2013;145:129–137.e123.

    Article  PubMed  Google Scholar 

  9. Horgan S, Jacobsen G, Weiss GD, Oldham JS, Denk PM, Borao F, Gorcey S, Watkins B, Mobley J, Thompson K, Spivack A, Voellinger D, Thompson C, Swanstrom L, Shah P, Haber G, Brengman M, Schroder G: Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results. Surg Obes Relat Dis 2010;6:290–295.

    Article  PubMed  Google Scholar 

  10. Spaulding L, Osler T, Patlak J: Long-term results of sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Obes Relat Dis 2007;3:623–626.

    Article  PubMed  Google Scholar 

  11. Loewen M, Barba C: Endoscopic sclerotherapy for dilated gastrojejunostomy of failed gastric bypass. Surg Obes Relat Dis 2008;4:539–542; discussion 542–533.

    Article  PubMed  Google Scholar 

  12. Abu Dayyeh BK, Jirapinyo P, Weitzner Z, Barker C, Flicker MS, Lautz DB, Thompson CC: Endoscopic sclerotherapy for the treatment of weight regain after Roux-en-Y gastric bypass: outcomes, complications, and predictors of response in 575 procedures. Gastrointest Endosc 2012;76:275–282.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Giurgius M, Fearing N, Weir A, Micheas L, Ramaswamy A: Long-term follow-up evaluation of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Endosc 2014;28:1454–1459.

    Article  PubMed  Google Scholar 

  14. Borao F, Gorcey S, Capuano A: Prospective single-site case series utilizing an endolumenal tissue anchoring system for revision of post-RYGB stomal and pouch dilatation. Surg Endosc 2010;24:2308–2313.

    Article  PubMed  Google Scholar 

  15. Mullady DK, Lautz DB, Thompson CC: Treatment of weight regain after gastric bypass surgery when using a new endoscopic platform: initial experience and early outcomes (with video). Gastrointest Endosc 2009;70:440–444.

    Article  PubMed  Google Scholar 

  16. Vargas EJ, Bazerbachi F, Rizk M, Rustagi T, Acosta A, Wilson EB, Wilson T, Neto MG, Zundel N, Mundi MS, Collazo-Clavell ML, Meera S, Abu-Lebdeh HS, Lorentz PA, Grothe KB, Clark MM, Kellogg TA, McKenzie TJ, Kendrick ML, Topazian MD, Gostout CJ, Abu Dayyeh BK: Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc 2018;32:252–259.

    Article  PubMed  Google Scholar 

  17. Patel LY, Lapin B, Brown CS, Stringer T, Gitelis ME, Linn JG, Denham WE, Farwell E, Haggerty S, Ujiki MB: Outcomes following 50 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-Y gastric bypass: a comparison of endoscopic suturing techniques for stoma reduction. Surg Endosc 2017;31:2667–2677.

    Article  PubMed  Google Scholar 

  18. Kumar N, Thompson CC: The pursestring technique for endoscopic revision of gastric bypass. Gastrointest Endosc 2015;82:956.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jirapinyo P, Slattery J, Ryan MB, Abu Dayyeh BK, Lautz DB, Thompson CC: Evaluation of an endoscopic suturing device for transoral outlet reduction in patients with weight regain following Roux-en-Y gastric bypass. Endoscopy 2013;45:532–536.

    Article  CAS  PubMed  Google Scholar 

  20. Riva P, Perretta S, Swanstrom L: Weight regain following RYGB can be effectively treated using a combination of endoscopic suturing and sclerotherapy. Surg Endosc 2017;31:1891–1895.

    Article  PubMed  Google Scholar 

  21. Borbély Y, Winkler C, Kröll D, Nett P: Pouch Reshaping for Significant Weight Regain after Roux-en-Y Gastric Bypass. Obes Surg 2017;27:439–444.

    Article  PubMed  Google Scholar 

  22. Marsk R, Jonas E, Rasmussen F, Näslund E: Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986-2006 in Sweden. Diabetologia 2010;53:2307–2311.

    Article  CAS  PubMed  Google Scholar 

  23. Carvajal SH, Mulvihill SJ: Postgastrectomy syndromes: dumping and diarrhea. Gastroenterol Clin North Am 1994;23:261–279.

    CAS  PubMed  Google Scholar 

  24. Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R: Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol 2009;6:583–590.

    Article  PubMed  Google Scholar 

  25. Gasser M, Meier C, Herren S, Aubry E, Steffen R, Stanga Z: Is testing for postprandial hyperinsulinemic hypoglycemia after gastric bypass necessary? Clin Nutr 2017

  26. Stier C, Chiappetta S: Endoluminal Revision (OverStitch (TM) , Apollo Endosurgery) of the Dilated Gastroenterostomy in Patients with Late Dumping Syndrome After Proximal Roux-en-Y Gastric Bypass. Obes Surg 2016;26:1978–1984.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Visceral Surgery, Hirslanden Clinic Beau-Site, Schaenzlihalde 1, CH-3013, Berne, Switzerland

    Catherine Tsai, Rudolf Steffen, Ulf Kessler, Hans Merki & Joerg Zehetner

Authors
  1. Catherine Tsai
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  2. Rudolf Steffen
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  3. Ulf Kessler
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  4. Hans Merki
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  5. Joerg Zehetner
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Contributions

Catherine Tsai participated in acquisition, analysis, and interpretation of data. Rudolf Steffen participated in interpretation of the data. Ulf Kessler and Hans Merki participated in design of the work. Joerg Zehetner participated in design of the work, analysis, and interpretation of data. All authors participated in drafting the work or revising it critically for important intellectual content, participated in final approval of the version to be published, and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Joerg Zehetner.

Ethics declarations

The study was approved by the local ethics review board.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Additional information

This paper was presented as an Oral Presentation in the Plenary Session at Digestive Disease Week (DDW) 2018 in Washington D.C., USA, on June 5, 2018.

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Tsai, C., Steffen, R., Kessler, U. et al. Endoscopic Gastrojejunal Revisions Following Gastric Bypass: Lessons Learned in More Than 100 Consecutive Patients. J Gastrointest Surg 23, 58–66 (2019). https://doi.org/10.1007/s11605-018-3961-0

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  • DOI: https://doi.org/10.1007/s11605-018-3961-0

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